Practice management
Informed Consent Checklist for Minor Clients
A practitioner needs to ensure they have clearly communicated the limits of confidentiality to both.
The initial sessions with a minor client require a careful conversation about what is kept private and what must be shared with their guardians. Navigating this talk is a delicate balance; the practitioner must build rapport with the young client while upholding their ethical and legal duties to the parents. A misstep here can compromise the therapeutic alliance before it has a chance to form.
This assessment helps formalize the discussion, ensuring both the minor and their guardians have the same grasp of confidentiality and the specific conditions for disclosure. It moves the verbal consent process to a concrete, shared reference point for all parties. As a result, everyone begins the work with a clear and mutual understanding of how information will be handled.
Informed Consent Checklist for Minor Clients
For the Minor Client
Read each statement and check the box to show you understand.
| Statement | I understand |
|---|---|
| What I talk about here is private. | ☐ |
| If I talk about seriously hurting myself, this information may have to be shared to keep me safe. | ☐ |
| If I talk about seriously hurting someone else, this information may have to be shared to keep them safe. | ☐ |
| If I talk about someone seriously hurting me, this information may have to be shared to keep me safe. | ☐ |
| I will be told before information is shared with others, unless it is an immediate emergency. | ☐ |
| My parents or guardians will know I am attending sessions, but they will not be told the specific things we discuss. | ☐ |
| I have had the chance to ask questions about how my information is kept private. | ☐ |
For the Parent(s) or Guardian(s)
Read each statement and check the box to confirm your understanding.
| Statement | I understand |
|---|---|
| My child’s conversations in these sessions are confidential. | ☐ |
| This confidentiality is necessary for my child to feel able to speak openly. | ☐ |
| I will be contacted immediately if there is a risk of serious harm to my child or to another person. | ☐ |
| Reasons for breaking confidentiality include risk of self-harm, threats of harm to others, and suspected abuse or neglect. | ☐ |
| I will not receive detailed reports about the specific content of my child’s sessions. | ☐ |
| I can receive general feedback on my child’s progress, as agreed upon. | ☐ |
| I have had the chance to ask questions about this confidentiality policy. | ☐ |
Minor Client Name: ____________________________
Signature: ____________________________ Date: _________
Parent/Guardian Name: __________________________
Signature: ____________________________ Date: _________
Parent/Guardian Name: __________________________
Signature: ____________________________ Date: _________
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